Anemia Flashcards
Anemia=
Is a decrease in the RBC count, hemoglobin and or hematocrit values resulting therefore in a lower ability of the blood to carry oxygen to body tissue
*its a sign of a disease process rather than a disease itself
RBCs=
Are flexible biconcave disk, with a very thin membrane which allows gases such as oxygen and co2 to diffuse easily across it
- mature erythrocytes have no nucleus
- immature erythrocytes are called reticulocytes
- life span is 120 days
- RBCs production process named: Erythropoiesis
- the most important hormone for erythropoiesis is ERYTHROPOIETIN (produced in the kidney )
Erythropoietin produced by the kidneys in response to :
Hypoxemia
Mean corpuscular volume (MCV):
-measure of the RBC average size
-allows classification of anemia (normocytic, micro/macrosytic)
-normal range= 80-90fl
MCV=10x HCT(%)/ RBC count
Mean corpuscular hemoglobin concentration (MCHC):
Measure the concentration of Hb in a given volume of packed RBCs
Normal range 32-36 g/dL
MCHC=Hb/HCT
Mean corpuscular hemoglobin:
Mean cell hemoglobin
Average mass of hemoglobin per RBC
MCH= Hb/RBC
Normal range 27-31 pg/cell
WHO grading of anemia:
Grade 1: (mild anemia) 10g/dL
Grade 2/ (moderate anemia) 7-10 g/dL
Grade 3:(severe anemia) below 7g/dL
Classification of anemia on the basis of cause :
1) hypo-proliferative : inadequate production (iron def., b12/folate def., aplastic anemia, anemia of chronic dis., marrow infiltration)
2) hemorrhagic: blood loss
3) hemolytic anemia: increased rbc destruction( immune/non-immune, thalassemia, rbc membrane/ metabolism disorder..)
Classification of anemia on the basis of morphology:
1)microcytic anemia (hypochromic) : MCV & MCH ⬇️ ex. Iron def. / thalassemia
2)normocytic anemia (normochronic):
MCV& MCH normal, ex. Blood loss , hemolytic , chr. Disease
3)macrocytic : MCV& MCH raised , ex. Megaliblastic anemias , hypothyrodism, liver disease and alcoholism , drug toxicity ( phenytoin)
Pathophys. Of anemia:
⬇️ in RBCs, Hb or Hct level
⬇️ O2 carrying capacity
Hypoxia and hypoxia induced effects on organ function
Signs and sympts of anemia
Signs of anemia :
1) pallor of the skin and of the mucos membranes
2) brittle nails
3) koilonychia (spoon shaped nails )
4) papillary atrophy of the tongue
5) angular stomatitis
6) brittle hair
7) dysphagia and glossitis
8) splenomegaly
Diagnosis of anemia:
1) physical examination and medical history ( signs and symptoms of anemia)
2) laboratory tests :
▪️CBC
▪️stool hemoglobin test
▪️peripheral blood smear
▪️iron level
▪️transferrin level
▪️ferritin
▪️vitamin B12
▪️bilirubin
▪️hemoglobin
▪️reticulocyte count
▪️liver / renal function tests
▪️ bone marrow biopsy
Normal values :
Hemoglobin: M(13.5-27.5)/ F(11.5-15.5) Hematocrit: M(40-53%)/ F(36-48%) RBCs: M(4.5-6.5)/ F( 3.9-5.6) MCH: 27-34 pg MCV: 80-95 fL MCHC: 30-35 g/dL Reticulocyte count : 50-150 x10*9/L
Iron deficiency anemia =
-Iron is essential for multiple metabolic processes including O2 transport, DNA synthesis and electron transport
-Iron deficiency anemia is caused by insufficient intake and absorption of iron and or iron loss from bleeding which can originate from a range of sources ( intestinal/ uterine or urinary tract )
🔸 each hemoglobin molecule is made up of 4 heme groups surrounding a globin group, and each heme is containing an Fe atom ( iron atom is attached to a ring-like porphyrin
🔸each heme group binds 1 o2 molecule -> hemoglobin binds 4 o2 molecules
Causes of iron deficiency anemia:
A) low dietary intake
B)increased demands
C) Malabsorption
* most common cause in developed countries is COLON CANCER , also long standing PEPTIC ULCER and bleeds
* most important cause of iron deficiency anemia in developing world children is PARASITIC WORMS
Total body iron mass=
- 5g women
- 5 men
- 80% functional body iron
- 20% iron storage ( hemosiderrin + ferritin)
Iron absorbed in the :
Duodenum
* low ph of gastric acid in the proximal duodenum allows ferric reductase enzyme to convert insoluble ferric (Fe+3) to absorbable ferrous (Fe+2)
Iron is transported by:
Hepcidin from the liver:
Ferroprtin:
Transfirrin
Prevents absorbtion of iron
Regulated by hepicidin
Hemosiderin:
Ferritin:
Is an aggregate of hundreds and thousands of ferritin particles plus amorphous proteins and lipids
-is the major iron storage protein in the body
Sympts of iron def. Anemia :
🔸shortness of breath 🔸feeling week or tired all of the time 🔸 cold hands and feet 🔸pallor 🔸 increased susceptibility of infection 🔸PICA- compunction of eating non food stuff 🔸 pagiphagia - craving ice
Associated condition to IDA:
▪️plummer - vinson syndrome
▪️achlorhydria
▪️glossitis and angular cheilitis
Lab findings in IDA:
- microcytic , hypochromic anemia
- ⬇️ serum ferritin
- ⬇️ serum iron
- ⬆️ serum transferrin
- ⬆️ EPO levels
- ⬆️platelet count
- ⬇️ Hb levels <11g/dL
- ⬆️RWD
Treatment of IDA :
✅oral iron therapy
✅if there is no improvement, the problem might be with absorption ( iv iron therapy) or there might be continued blood loss
***always treat the underlying cause
Medication classification:
🔸monocomponent tab:
Iron polyisomaltozate, iron gluconate , iron sulfate , iron fumarate, iron chloride
🔸contained ascorbic acid: sorbent durules, pheroplex
🔸contained folic acid : maltofer , foul , gyno-tradyferon
Differential diagnosis of IDA:
1) sideroblastic anemia - excess of iron , and defect in heme synthesis of rbcs mitochondria
2) anemia of chronic disease -increase in hepicidin
Megaloblastic anemia:
Hemoglobin production is normal
🔸defect in nuclear replication and division
🔸affects all marrow elements
🔸oval macrocyte , hypersigmented neutrophils
MBA has 2 major causes :
1) lack of VitB12 or cyanocoblamin
2) folate deficiency
Other findings of MBA:
Pancytopenia reticulocytopenia LDH⬆️ Serum iron is normal/ ⬆️ Serum B12 or folate⬇️
2 different entities of MBA:
▪️pernicious anemia- ⬇️RBCs occurs when the body cannot properly absorb VitB12 from GIT
▪️folate deficiency anemia -⬇️ RBcs due to lack of folate or lower than normal amount of folic acid in blood
Causes of MBA:
- lack of intrinsic factor in stomach
- alcohol abuse
- poor dietary intake
- VitaminB12- free diet
- intestinal dysfunction
- certain medications such as PHENYTOIN
Signs and sympts of MBA:
-Megaloblastic anemia , pancytopenia
-Paresthesias, peripheral neuropathy, combined system disease
-irritability, personality change , mild memory impairment, dementia, depression, psychosis
-possible ⬆️ risk of MI and stroke
🔸muscle weakness, paresthesia, atrophic glossitis, headache , pallor and weight loss
Lab findings of MBA:
1) Hb⬇️
2) Hct⬇️
3) RBCs ⬇️/normal
4) MCV⬆️
5) MCH⬆️
6) MCHC normal
7) reticulocytopenia
8) total WBCs- normal/ ⬇️
9) platelet count- normal/⬇️
10) pancytopenia , if severe
Pernicious anemia:
Autoimmune destruction of parietal cells
- Abs versus parietal cells -> intrinsic factor def. And achlorhydria
- accompanied by⬆️ incidence of gastric cancer
- often associated with other immune diseases
Schilling test :
-oral radioactive B12 is given
- then an Iv injection of non radioactive B12 is performed in order to staurate B12 binding proteins and to flush out Co-B12
-the urine collected for 24 hrs
-Normal person will excrete >10% of the oral dose
If <10% repeat test with addition oral IF
-if now normal the diagnosis is pernicious anemia
-if still abnormal , the lesion must be located in the terminal ileum
Treatment of MBA:
✅if necessary, transfuse with care ( when hemoglobin l<7 g/dL)
✅folic acid tablets
✅slowly developing anemia, usually well compensated
Hemolytic anemia =
- hemolysis is the destruction or removal of RBCs from the circulation before their normal lifespan of 120 days
- are defined as an increase in destruction of RBCs
- because of the compensation from the bone marrow so the anemia appears when destruction of RBCs is more important than compensatory mechanisms
Polychromasia:
- abnormally high number of immature cells in the bloodstream as a result of being prematurely released
- hemolysis-> erythroid hyperplasia-> immature RBcs goes to circulation-> reticulocytosisand polychromasia
Causes of hemolytic anemia:
1) hereditary is due to intrinsic RBCs defect
2) acquired- are due to environmental changes
3) intravascular hemolysis- When the destruction of RBCs takes place in the blood vessels and hemoglobin is released
- is associated with physical trauma , like an artificial heart valve.
Hereditary causes of Hemolytic anemia :
1) RBCs membrane defect
2) RBCs cell enzyme deficiency
3) disorders of Hb synthesis
Signs and symptoms of hemolytic anemia :
1) pallor
2) FLUCTUATING JAUNDICE
3) urine - no bilirubin but presence of urobilinogen
4) gallstones are common
5) SPLENOMEGALY
Lab diagnosis of HA:
1) Reticulocytosis
2) bone marrow biopsy, erythroid hyperplasia
3) ⬆️serum bilirubin levels
4) ⬆️ the urinary urobilinogen, stercobilinogen ⬆️
5) ⬇️ plasma haptoglobin
6)⬆️LDH
7)positive coomb’s test
8) Hb⬇️, MCV is normal/ slightly ⬆️, MCHC ⬆️, RDW ⬆️
9) peripheral blood smear - poikilocytosis and polychromatiphilia
